Doxycycline and Risk for Pregnancy Loss : A Multi-database, Multi-indication Cohort Study.

First-trimester oral doxycycline exposure is linked to higher pregnancy loss risk than comparator antibiotics in reproductive-aged women, with adjusted risk ratios up to 1.54 in MarketScan.

• Why it matters: Evidence on doxycycline safety in early pregnancy is limited, despite frequent prescribing to reproductive-aged women and uncertainty about pregnancy loss risk.
• What they did: In retrospective active-comparator cohorts using Merative MarketScan (2005–2021) and Medicaid claims (1999–2019), pregnancies with first-trimester doxycycline were propensity-score and gestational-age matched to amoxicillin or macrolides for RTI, or topical clindamycin for acne.
• The result: For RTI, doxycycline showed increased pregnancy loss versus amoxicillin (MarketScan aRR 1.54; Medicaid aRR 1.40) and versus macrolides (MarketScan aRR 1.39; Medicaid aRR 1.36); for acne, MarketScan was significant (aRR 1.49) but Medicaid was not (aRR 1.03), with risk differences of 7–11 percentage points where significant.

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